若年（55歳未満）患者におけるB型大動脈解離の長期予後

The purpose of this study is to review all TBAD cases treated at a single institution to identify any significant differences in clinical outcomes during long-term follow-up between younger (<55) and older (≥55) patients.

Data was collected from patients admitted to a single center with a diagnosis of type B aortic dissection over a ten-year period 2012 to 2022. Data collected included demographics, comorbidities (e.g. genetic conditions, smoking, drug abuse, diabetes, renal disease, hyperlipidemia, and hypertension), level of entry tear, treatment type, and patient outcomes. Major endpoints included survival, progression of dissection or aneurysmal degeneration, and need for follow-up intervention.

175 TBAD patients were identified (<55, n = 71; ≥55, n = 104). Patients aged ≥55 years had a significantly higher prevalence of COPD (30.6% vs. 16.9%, p = 0.0394), while younger (<55) patients more frequently reported drug abuse (22.1% vs. 8.7%, p = 0.0131). No significant difference in overall survival was noted between age groups. The survival curves are similar for the first three to four years following dissection, with the younger cohort having improved survival rates over the next several years, until the curves meet again at ten years following dissection. However, among patients <55 years, those treated with TEVAR had significantly higher survival compared with those treated conservatively (p = 0.0365).

In this retrospective cohort, TEVAR-used selectively for symptomatic or high-risk TBAD-was associated with better long-term survival in younger (<55-year) patients compared with medical therapy alone. These hypothesis-generating data suggest that early endovascular repair may be beneficial in carefully selected young patients, but do not justify broad prophylactic expansion of TEVAR indications; prospective studies are required.